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Severe Acute Respiratory Syndrome

Severe acute respiratory syndrome (SARS) is a prototypical emerging infectious disease that, largely because of global travel, instead of remaining an obscure respiratory infection in South China became a global public health crisis. By the time the outbreak ran its course, over 8,000 cases were identified from 29 countries with an overall 10% fatality rate.

Global attention toward the outbreak was first drawn in March 2003 with the recognition of cases of severe acute respiratory illness among patients in the Guangdong province of China, Hong Kong, Vietnam, Singapore, and Canada. The World Health Organization (WHO) issued a global alert and coined the term severe acute respiratory syndrome (SARS) for the disease. By April 2003, the WHO had to take the unprecedented step of issuing a travel advisory for the Guangdong Province and for Hong Kong, later broadened to other countries. Eventually, the etiologic agent was identified as a novel coronavirus (SARS CoV), likely a virus that jumped species from the civet (catlike delicacy in China) to humans. The initial zoonotic transmission was followed by subsequent nosocomial and human-to-human transmission perpetuating a widespread global epidemic. Most patients presented with fever, cough, shortness of breath, and reported either close contact with a person with SARS or a history of travel or residence in an area with recent local SARS transmission. The chest radiograph would reveal findings of pneumonia or acute respiratory distress syndrome, with some cases progressing on to require ventilatory support. Supportive treatment remained the mainstay of clinical care.

Initial cases of SARS were reported from Guangdong Province, China, in November 2002 with almost 800 cases noted by February 2003. A physician with SARS contributed to the subsequent widespread dissemination of the disease by traveling from Guangdong to a hotel in Hong Kong and infecting 10 other individuals who then traveled widely, perpetuating outbreaks in their countries of destination.1 Most severe illness occurred in adults, with children, if infected at all, developing a milder illness. Patients older than 60 years had a higher mortality, with a case fatality rate up to 43%. Twenty-nine countries in Asia, Europe, and North America were affected with 83% of the reported cases hailing from China and Hong Kong. Table 12-1 depicts the timeline of the SARS outbreak.